Neuromuscular Conditions (CP, Spina bifida and muscular dystrophy) Flashcards
Prenatal causes of cerebral palsy
Placental insufficiency Toxaemia Smoking Alcohol Drugs Infection ToRCH
Perinatal causes of CP
pre-maturity Anoxic injuries Infection Kernicterus Eythroblastosis fetalis (HDN)
Post natal causes of CP
Infection - CMV, rubella
Head trauma
What is cerebral palsy
Permanent and non-progressive motor disorder due to brain damage before birth or during first 2 years of life
Lesion is static but clinical picture is not
What are the physiological classifications of CP
Spastic (pyramidal system, motor cortex)
Athetoid (extrapyramidal system, basal ganglia)
Ataxia (cerebellum and brainstem)
Rigid (basal ganglia and motor cortex)
Hemiballistic
Mixed (combination of spasticity and athetosis)
What are the anatomical classifications?
Monoplegia
Hemiplegia
Diplegia
Quadriplegia or total body involvement
What is needed for diagnosis of CP
Spasticity, lack of voluntary control, weakness, poor co-ordination, sensory impairment
Persistence of 2 or more primitive reflexes usually means child will be non ambulatory
Management of CP
Motor, sensory, cognitive problems, epilepsy, feeding difficulties, behavioural problems
What are the prerequisites of normal gait?
Stability in stance Clearance in swing Preposition of foot Adequate step length Energy conservation
What is antalgic gate?
Reduced stance phase
What is trendelenburg gate?
Pelvis drops on opposite side to foot standing on
Caused by weakness of abductor muscles of lower limb and gluteus medius and minimus
What are concentric muscle actions
Shortening
Power generation
Acceleration
What are eccentric muscle actions
Controlled lengthening
Power abrorption
deceleration
What is GMFCS
Grading on CP patients ability to walk
Levels 1-5 with 5 most severe
What is spina bifida
Failure to close neural tube
What are the types of spina bifida
Occulta (benign)
Meningocele (rare, cyst removed, usually neurologically intact)
Myelomeningocele (nerve roots in cyst or exposed
Encephalocele
Anencephaly
Complications of Myelomeningocele
Hydrocephaly Chiari II malform Tethered cord Urinary tract problems Locomotor limitation Latex allergy (3/4) Learning disability (1/5)
What is protective for spina bifida
Folic acid
What is muscular dystrophy
Progressive muscle weakness
\What are some types of muscular dystrophy
Facioscapulohumeral Duchenne Becker's Limb girdle Myotonic Oculo-pharyngeal Emery Dreifus
What is used in diagnosis of muscular dystrophy?
Muscle biopsy
DNA
Blood enzymes (creatinine kinase) and EMG
What is creatinine kinase released by
Damaged muscles
What are features of duchenne muscular dystrophy
X-linked recessive Failure to make dystrophin Proximal weak 4yrs 'psuedohypertrophy' (muscles become swollen with fat) Wheelchair by 12yrs Most get scoliosis Surgery indicated
Features of becker muscular dystrophy
?Same gene as duchenne but there is limited but poor dystrophin
Milder than duchenne
Later onset
Wheelchair by 30years
What sign is pathonomic for muscular dystrophy?
Gower Maneuver
